Camm, AJ;
Steffel, J;
Virdone, S;
Bassand, J-P;
Fox, KAA;
Goldhaber, SZ;
Goto, S;
Haas, S;
Turpie, AGG;
Verheugt, FWA;
et al.
Camm, AJ; Steffel, J; Virdone, S; Bassand, J-P; Fox, KAA; Goldhaber, SZ; Goto, S; Haas, S; Turpie, AGG; Verheugt, FWA; Misselwitz, F; Herreros, RC; Kayani, G; Pieper, KS; Kakkar, AK; GARFIELD-AF Investigators
(2023)
Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF.
Eur Heart J Open, 3 (3).
oead051.
ISSN 2752-4191
https://doi.org/10.1093/ehjopen/oead051
SGUL Authors: Camm, Alan John
Abstract
AIMS: This study aimed to identify relationships in recently diagnosed atrial fibrillation (AF) patients with respect to anticoagulation status, use of guideline-directed medical therapy (GDMT) for comorbid cardiovascular conditions (co-GDMT), and clinical outcomes. The Global Anticoagulant Registry in the FIELD (GARFIELD)-AF is a prospective, international registry of patients with recently diagnosed non-valvular AF at risk of stroke (NCT01090362). METHODS AND RESULTS: Guideline-directed medical therapy was defined according to the European Society of Cardiology guidelines. This study explored co-GDMT use in patients enrolled in GARFIELD-AF (March 2013-August 2016) with CHA2DS2-VASc ≥ 2 (excluding sex) and ≥1 of five comorbidities-coronary artery disease, diabetes mellitus, heart failure, hypertension, and peripheral vascular disease (n = 23 165). Association between co-GDMT and outcome events was evaluated with Cox proportional hazards models, with stratification by all possible combinations of the five comorbidities. Most patients (73.8%) received oral anticoagulants (OACs) as recommended; 15.0% received no recommended co-GDMT, 40.4% received some, and 44.5% received all co-GDMT. At 2 years, comprehensive co-GDMT was associated with a lower risk of all-cause mortality [hazard ratio (HR) 0.89 (0.81-0.99)] and non-cardiovascular mortality [HR 0.85 (0.73-0.99)] compared with inadequate/no GDMT, but cardiovascular mortality was not significantly reduced. Treatment with OACs was beneficial for all-cause mortality and non-cardiovascular mortality, irrespective of co-GDMT use; only in patients receiving all co-GDMT was OAC associated with a lower risk of non-haemorrhagic stroke/systemic embolism. CONCLUSION: In this large prospective, international registry on AF, comprehensive co-GDMT was associated with a lower risk of mortality in patients with AF and CHA2DS2-VASc ≥ 2 (excluding sex); OAC therapy was associated with reduced all-cause mortality and non-cardiovascular mortality, irrespective of co-GDMT use. CLINICAL TRIAL REGISTRATION: Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.
Item Type: |
Article
|
Additional Information: |
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits
non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. |
Keywords: |
Atrial fibrillation, Comorbidity, GARFIELD-AF, Guideline-directed medical therapy, Mortality, Oral anticoagulant, GARFIELD-AF Investigators, Atrial fibrillation, Comorbidity, GARFIELD-AF, Guideline-directed medical therapy, Mortality, Oral anticoagulant |
SGUL Research Institute / Research Centre: |
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) |
Journal or Publication Title: |
Eur Heart J Open |
ISSN: |
2752-4191 |
Language: |
eng |
Dates: |
Date | Event |
---|
May 2023 | Published | 19 May 2023 | Published Online | 20 April 2023 | Accepted |
|
Publisher License: |
Creative Commons: Attribution-Noncommercial 4.0 |
Projects: |
Project ID | Funder | Funder ID |
---|
UNSPECIFIED | Thrombosis Research Institute | UNSPECIFIED |
|
PubMed ID: |
37293139 |
|
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/115454 |
Publisher's version: |
https://doi.org/10.1093/ehjopen/oead051 |
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